Romania’s recent measles outbreak offers a stark warning as other countries face rising cases. Last year Romania—an upper-middle-income EU member—reported 30,692 measles cases and 23 deaths; five of those deaths were infants under 1, according to Dr. Aurora Stanescu of the National Institute for Public Health. Public health experts call the scale of the outbreak a wake-up call: measles deaths shouldn’t happen where safe, effective vaccines are widely available, says Nina Schwalbe of Georgetown’s Center for Health Policy and Politics.
How coverage fell
Romania’s decline in measles immunity has many roots. Under the communist regime, childhood vaccines were mandatory and often given in schools without parental consent. After the measles vaccine was introduced in 1979, cases fell roughly 90% and coverage climbed above the 95% threshold public health experts set for interrupting measles transmission.
The end of compulsory vaccination after the 1989 political transition opened space for refusal. Greater personal freedom, growing distrust of state institutions, and the association of mandates with authoritarian control pushed some families to reject vaccines. Public controversy around a 2008 HPV vaccine campaign further eroded trust; media attention and political debate about that program appears to have dented confidence in immunization more broadly.
Measured coverage fell steadily: what had hovered near 95% slipped by roughly 20 percentage points by 2017 and reached about 62% by 2023. A 2024 study found only one of Romania’s more than 40 regions still had measles coverage above 95%.
Health system and access problems compounded the decline. Routine immunization services were disrupted during the COVID-19 pandemic. Romania’s health system remains underfunded relative to other EU countries; primary care faces workforce shortages, burnout, and low pay. Mandatory immunization policies are gone, and outreach is uneven—disproportionately affecting marginalized groups such as nearly 2 million Roma people, many of whom lack local family doctors and access to vaccination services.
Social and political amplifiers
Beyond barriers to access, social forces amplified hesitancy. In some areas clergy have spoken against vaccines, partly in response to pandemic-era restrictions on services. Populist and far-right politicians have exploited mistrust for political gain—one anti-vaccine lawmaker declared, “God is not vaccinated.” Such rhetoric deepens parental fears and normalizes refusal.
Consequences for children and communities
Only about two-thirds of Romanians are now fully vaccinated against measles—the lowest rate in the EU. Measles is extremely contagious: a single infected person can infect up to 18 nearby unprotected people. The standard two-dose schedule—first dose around 12 months and the second before school—protects most children, but infants under 12 months are especially vulnerable.
Families have felt the human cost. A mother, Ionela Radulescu, described watching her 7-month-old son, too young for his first dose, become ill after exposure and being hospitalized for pneumonia. She recalls the fear and self-blame parents can experience when a preventable infection spreads through a community.
Clinically, measles can cause pneumonia, eye inflammation, diarrhea and ear infections that in some cases lead to hearing loss. Romania has reported about a dozen recent cases of subacute sclerosing panencephalitis (SSPE), a rare but fatal complication that can appear seven to ten years after measles infection.
Attempts to rebuild trust and coverage
Romanian clinicians and public health workers are using evidence-based approaches to try to rebuild vaccine confidence. Pediatricians and family doctors emphasize respectful, two-way conversations that address parents’ concerns rather than dismiss them. Dr. Gindrovel Dumitra uses motivational interviewing—an approach that avoids judgment, elicits a person’s own reasons for change, and checks understanding—to help hesitant parents decide on vaccination. Small, trust-building dialogues and tailored information have persuaded some families to accept vaccines.
International and domestic health agencies including the WHO support sustained outreach, improved access, and communication strategies designed to restore confidence. Still, reversing years of declining coverage, repairing under-resourced primary care, and countering politicized misinformation present major challenges.
Broader implications
Romania’s experience underscores a broader principle: when high vaccination coverage erodes, measles returns—even in relatively well-off countries. Canada recently lost its measles elimination status after sustained transmission, and the United States reported more than 1,700 cases in 2025, its highest total in decades.
The lesson for other countries is clear. Maintaining measles control requires consistent access to vaccines, adequately funded and staffed health systems, respectful trust-building communication, and vigilance against politicized misinformation. Where those elements falter, measles and other vaccine-preventable diseases can and will resurge.
Michal Ruprecht is a Stanford Global Health Media Fellow.